Recent evidence from the Healthy People 2010 suggests that dental health disparities between the wealthy and poor persist and are widening. Past research has attributed unequal access to healthcare to unequal distribution of economic, social, and political resources. Yet, recent studies have shown even with insurance coverage to reduce the cost of care, Medicaid patients have a low level of dental care utilization. The primary objective of this research training fellowship is to examine patterns of dental care utilization among Medicaid patients within a complex web of factors at the macro level (Oregon State Health Care Policy Reforms), the intermediate level of the social and cultural environment of patient and dentists, as well the effects of dentist's' knowledge, attitudes, and practices on Medicaid patients' patterns of utilization. Using fime series analyses of Medicaid eligibility and claims data, and survey data from a HRSA sponsored project "Provider Payment and Dentistry for Poor Pregnant Women", the specific aims of this project are to: 1) to conduct time series analysis to examine an ever-changing healthcare policy environment on utilization of dental care among Medicaid patients; 2) examine the role of dental provider's knowledge, attitudes, and practices on Oregon Medicaid patient's utilization of dental care, particularity the appropriateness of dental care procedures for Medicaid women of reproductive years; and 3) examine across varying time periods the roles of macro level factors associated with the Oregon Health Plan policy changes; intermediate factors related to the socio-economic environment of the patients, and micro level factors related to dentists' attitudes, knowledge, and practices on Medicaid patients, on the utilization patterns of dental care insurance among Medicaid patients. Public Health Relevance: This research addresses Goal 6 of the NIDCR Strategic Plan Goal 6 and also ARHQ missions and strategic goals 3 in identifying strategies to improve access to health care, particularly for vulnerable populations, foster appropriate use, reduce unnecessary expenditures, and reducing health disparities in the United States. Keywords: Oral Health, Medicaid, Oral Health Care Utilization, and Health Care Policy Reforms